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Towards Excellence : Driving up Quality Across the East Midlands Health and Social Care Conference 25 February 2010. Why has the NHS been so poor at engaging the third sector? What is changing? The quality and productivity challenge. Main Themes. ‘Failure’ of Commissioning. - PowerPoint PPT Presentation


  • Towards Excellence:Driving up Quality Across the East Midlands Health and Social Care Conference 25 February 2010


  • Main ThemesWhy has the NHS been so poor at engaging the third sector?

    What is changing?

    The quality and productivity challenge

  • Failure of CommissioningNHS has commissioned for two decades, but

    Commissioners capability has been limitedFew levers, not well used Inadequate regulatory regime bail out of NHS providersLow investment in developing commissioners Highly variable & fragmented practiceLack of legitimacy (linked to voice & patient /public engagement)Very limited range of providers

  • An unfair playing fieldLack of awareness amongst commissioners of the Third SectorInconsistency of procurement and regulatory practicesGreat variation in when/whether to use grants or contractsBurden of disproportionate procurement practices pre-qualification requirements, guarantees/bondsPoor funding practice: lack of full cost recovery > subsidy Poor funding practice: short-termism = barrier to investmentBurden of disproportionate monitoring

    Working with the Third Sector National Audit Office June 2005

  • An unfair playing field

  • The Commissioning Framework for Health and Well-being

  • Assuring high quality providers for all servicesObstacle:Providers are sometimes unwilling or unable to provide new and innovative servicesSolution:Commissioning focused on outcomesWider range of providersDevelop effective, strong partnerships with providers Transparent and fair procurementMore innovative provision, tailored to the needs of individuals (engage providers in needs assessments)Intelligent decommissioning

  • Quality & Productivity ChallengeThe population has increased 24% over the 60 years of the NHSMore people now over pension age than under 16By 2031 the 75+ population will double to 8.2 millionHalf of babies born today will live to be 100Men and women live 10 years longer than in 1948Time lived with a limiting illness or disability has increased by over two years in past decadeAlzheimers and other forms of dementia will double in a generationDemographic change will cost the NHS 1.11.4 bn extra each year

    Source: The Human Factor, NESTA, 2009*

  • *1.4 bn challengeFlat cash scenarioThe scale of the challengeGrowth in AllocationsTrajectory of rising costs

  • Our AimThe aim of the Towards Excellence programme is to drive up the quality of healthcare across the East Midlands, and ensure we have the resources to meet the challenges of:

    Demographic changeIncreasing costs of drugs and technologyRising demandGrowing expectations


  • NationalRegionalCounty health systemOrganisationTeam / IndividualCo-ProductionSubsidiarityClinical LeadershipSystem AlignmentResponding to the Challenge - levels of workingPCT / Provider*

  • 12 National Priorities Confirmed*

    Priority Lead Primary Care Contracting Dame Barbara Hakin Technology / Digital Vision Peter Spilsbury Procurement Phillipa SlingerSupporting staff productivity Lorraine Foley (NHSI) Back Office Efficiency Tony SpotswoodDrugs Prescribing Peter RoweClinical Support Rationalisation Dr Ian Barnes Right Care - Decommissioning - Threshold, referral/conversion management - Patient decision support Sir Muir Gray Safe Care Maxine Power (DH) Pathway - Long Term Conditions Overall Sir John Oldham (DH) Pathway - Acute - Urgent & Emergency Care Sir John Oldham (DH) Pathway - End of Life Sophia Christie (BENPCT)

  • East Midlands PrioritiesClinical Priorities189 321mPotential opportunityTransformation of the Urgent Care System45 - 85m1Delivery of upper quartile performance in planned care7 17m2VTE prevention3 - 6m3Long term conditions management - best practice pathways67 - 68m4End of Life care best practice10 - 26m5Large scale prevention programmes25 - 62m6Reduction in caesarean section rates1 4m7Reducing out-of-area placements for people with learning disabilities1 - 21m8Significant reduction in prescribing and drug procurement costs31m98*Initial Priorities: Falls and Dementia

  • Non-Clinical Priorities355 512mPotential opportunityWorkforce productivity169 -176m1Rationalise back-office functions and supply chain management 25m2Major improvement in productivity of Pathology services20 - 40m3Introduce standard thresholds for surgery6 - 69m4Estates optimisation 72 112m5Reduce Variation and Maximise Capacity 3 - 27m6Reduce costs of primary care contracting (LES, DES)34 - 37m7Reduce costs of Continuing Care 27m8*

  • Quality ObservatoryEast Midlands QO was launched on 1 DecemberIt will provide the main mechanism to measure and track quality improvementsAccess to the data on the website is currently restrictedIt will gradually be opened to all*

  • *

  • Our Next StepsEstablish priority work streams, with high quality leadershipSet up PMODevelop detailed plan for each initiativeDevelop county health system assurance plansCloser alignment with local government / social careProduce SHA Delivery PlanWidespread communication and engagement*



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